Talk:Methylphenidate/Archive 2

Cherry-picking and misrepresentation

What is it about this article that attracts so many editors willing to misrepresent their sources? Blatant examples we've seen recently include a claim made about a study showing, purportedly, that "children treated with Ritalin are three times more likely to develop a taste for cocaine". The only problem is that the cited reference shows no such thing. The reference only touches on one study which even had human subjects involved; the results of that study said nothing about the figure of "three times more likely", and due to the structure of the study, it couldn't have made a meaningful statement about how much more likely a "taste for cocaine" became. Why? Because the subjects in the study were all selected because they had taken cocaine at least once. That means that if only 0.1% of the people who were treated with methylphenidate for childhood ADHD ever sampled cocaine, that fact would not be reflected by the study, because the study is ignoring the 999 who didn't try cocaine and examining only the one who did.

And now let's consider this text:

Why, then, aren't the 4 million to 6 million kids who take Ritalin daily acting more like the Studio 54 crowd, circa 1977? One important difference is that Ritalin, administered as directed, acts much more slowly than cocaine. Nora Volkow, a senior scientist at Brookhaven National Laboratory who has done extensive research on methylphenidate, found in a 2001 study that Ritalin takes upward of an hour to raise dopamine levels; cocaine, a mere seconds. The exact reason why the uptake speed matters is unknown, but it seems to account for the different effects.

→"The exact reason why the uptake speed matters is unknown"

The exact reason why the uptake speed matters is that, Clearly, the uptake speed is going to alter significantly depending on its route of administration so the reason why the uptake speed matters is that it also explains the difference in the experiences of the cocaine user and the methylphenidate user...

If Methylphenidate is "administered as directed" (Which of course means swallowed) and the cocaine is (surely) 'snorted'.

Cocaine gives the user a high... feelings of euphoria, stimulation, a feeling of being a bit like a king - when absorbed intranasally.

Whereas Methylphenidate has a more subtle effect on the reuptake of dopamine in the brain which increases slowly for up to an hour after administration gives the user a feeling of focus, mild stimulation, with very little recreational value - when swallowed.

Shoving a drug up your hooter is going to result in a faster more overwhelming uptake than swallowing it. And in the case of cocaine, just as with Methylphenidate, swallowing it just isn't fun!

My honest opinion having had Way more experience of snorting both substances than anyone in the world. I actually PREFER methylphenidate over cocaine, because while the physical effects are almost identical, the high from Methylphenidate is very noticeably clearer, more composed and free from the usual anxiety which inevitably accompanies cocaine (mis)use. Methylphenidate's effects allow for normal (well actually more efficient and motivated) functioning.

Methylphenidate insufflation produces a similar high to that of Cocaine - Only with a greater feeling of compassion for and empathy with others, it's more pleasant, more positive and uplifting, your feeling of self confidence becomes almost overwhelming and all the while you are able to focus on any task like you're actually using a larger proportion of your brain. Mentally -after Methylphenidate... You are a superhuman. If both drugs are administered the same way - Methylphenidate is not just similar to cocaine... It's significantly better.

provided personal experience to elucidate the reader's understanding of the subject matter.

Now we are using the source that text comes from as a reference in the article -- but are we citing it to clarify for the reader that methylphenidate correctly administered has different effects from cocaine? No, we are not. This, instead, is the statement that uses that source as a reference:

The similarities between methylphenidate and cocaine have prompted concern that the unknown dangers of methylphenidate could be similar to the known dangers of cocaine.

The article says nothing about "the unknown dangers of methylphenidate". At best -- at best -- we could possibly infer from the article that someone is concerned by the chemical similarities between methylphenidate and cocaine. However, it is hard to imagine how anyone could have in good faith read that article and decide to cite it just for what it implies about "concern" about similarities, and not a single bit of the factual information it provides about the differences. -- Antaeus Feldspar 17:44, 27 November 2006 (UTC)

See my comment here for a small conversation about the differences. Cocaine and methylphenidate are two very different molecules with little in common structurally. A mention in the article regarding the differences really isn't necessary. -Muugokszhiion 22:54, 9 January 2007 (UTC)

cocaine similarity section misleading

A discussion of similarities between ritalin and cocaine that ends with a mention of amphetamine as a third common stimulant implies that ritalin and cocaine are more similiar to each other than to amphetamine. It is my understanding that methylphenidate is in the same class of drugs as amphetamines.

-No it's not that's a popularly held misconception.

Additionally, the statement that ritalin is like low dosage long acting cocaine suggests that taking a small dose of cocaine regularly would have the same effects as ritalin. This statement is either patently false, or from a study that is not widely accepted(or known) by experts. - Jpstead 17:09, 29 November 2006 (UTC)

Methylpheniate is pretty much a substituted amphetamine and is thus much more similar to dextroamphetamine than it is to cocaine, a tropane alkaloid. In a comparison between MPH and d-AMP, the only differenes I can see are found at the R_ß, R_N and R_α positions (the latter two of which close to form a piperidyl-like ring; the molecule is clearly related to phenethylamine. Cocaine is a much more complicated and different story. Some similarities include the carboxylate and phenyl groups, but they're in much different positions and it would take an organic chemist to be able to draw accurate comparisons. Even without a knowledge of chemistry, one could see the similarities between MPH and d-AMP just by looking at the molecules. Cocaine is more similar to atropine than it is to MPH or d-AMP.

Yes, cocaine and atropine are both tropane alkaloids, but their pharmachologies are radically different. While atropine affects cholinergic neurons, cocaine affects dopaminergic neurons. In this respect, cocaine is more similar to methylphenidate.--Metalhead94 (talk) 00:43, 27 August 2008 (UTC)

Because cocaine and methylphenidate are both stimulant drugs, and stimulant drugs may increase focus, I can see where one might make the assumption that cocaine would be effective. It has in the past been tested experimentally for this reason, but has been found to be much less effective than MPH in clinical and experimental trails, not to mention more addictive by an enormous magnitude; thus, it is never used. I've made a couple of changes that I hope should clear up the confusion. -Muugokszhiion 22:52, 9 January 2007 (UTC)

Cocaine and Methylphenidate share a similar mechanism of action, Both are Dopamine & Noradrenaline reuptake inhibitors however Methylphenidate has the more potent effect of the two because it binds to additional receptor sites.

overprescription inclusion

The heading "overprescription" is followed by studies which suggest ritalin is underprescribed. I edited the section by adding the "some have asserted" part, but really there seems no reason for the section to be there absent any evidence of overprescription. The section would be very long indeed if someone asserting something was enough to warrant a section. Research, which I don't have the time to collect and include right now, suggests that among certain demographics ritalin may well be overprescribed, but among others is underprescribed. The section would make sense if it discussed these issues. - Jpstead 17:08, 29 November 2006 (UTC)

TBI and Methylphenidate

I had a moderate frontal-temporal closed head injury several years ago, and all of my ADD-like symptoms began just after it. Some experts do say that true ADD is impossible if the symptoms appear after age 7 (which they certainly did.) However, I can now say from personal experience that for this type of head injury, stimulant medications work exactly the way they are supposed to for ADD patients. I can calm down, concentrate, and focus for the first time in MANY years. I'd really like to see some information about the effects of this medication for TBI survivors-- as of now, I think there's only a brief mention with no details.

-- Anise 71.228.235.161 01:21, 7 December 2006 (UTC)

In fact, the ADD symptoms were historically first linked to brain injury, due to the effects of encephalitis caused by the Spanish flu around 1920. Check out the History section on the ADHD page. --IanOsgood 16:12, 23 May 2007 (UTC)

Risk of death

Edited to more accurately represent the work of FDA advisory committees. More to come, if I have time. YeahIKnow 20:32, 18 December 2006 (UTC)

Um... is that a trustworthy article? I am not by any means challenging your statement, I am simply asking is it not possible that these deaths could be random? I mean if we started noting how many people died of wearing slippers we would surely find numbers. Is it really necessary to keep that part? I am sorry for my doubts but I would really like to hear opinions regarding this. "The non registered one"

Balance needed in a few sections

Overall, this article is well-written, especially given its inherently polarizing subject. Kudos to those involved.

I'm a 44 year old male and take Concerta daily. And as a physical scientist, I researched the so-called "controversy" before I began taking it 3 years ago. I apologize for not providing citations, but I just stumbled across this and wanted to weigh in on two points, in particular.

First, the stimulant/"my kid's a zombie" paradox is far better understood these days. Brain scans (PET, I think) of people with ADHD/ADD show they typically have decreased baseline activity in their pre-fontal cortex. This region of the brain is associated with Executive Function, thought to be responsible for e.g. "future consequences of current activities,...prediction of outcomes, expectation based on actions,...the ability to suppress urges."

MPH is an amphetamine; but the net effect is to stimulate that specific area of the brain responsible for impulse control. Children and adults with ADHD/ADD benefit from a psycho-stimulant because it makes them more able to consider the consequences of their actions, control impulsive behavior, and focus their energy towards long-range goals. In short, a "hyperactive" ADHD child is not disruptive simply due to the natural surfeit of youthful energy, but because the brain function that allows them to control -- and learn to control -- that energy, is under-active.

Lastly, the "addiction" section neglects the important "chicken and the egg" relationship between cocaine use and undiagnosed ADD in adults -- not to mention their often heroic caffeine consumption. Because of the similarities between MPH and cocaine, many adults first diagnosed with ADD as adults have a history of cocaine use, myself included. It's been postulated that undiagnosed ADD may result in cocaine use, as adults intuitively prefer --and sadly become addicted to -- the drug that initially best resolves years of struggling to succeed. Todd Johnston 10:48, 27 December 2006 (UTC)

Excellent comment! I've tried to balance the section further in recent edits by raising the point you made in your last paragraph. In my experience in psychiatry, I've noticed that some ADD/ADHD adolescents and adults consciously or unconsciously attempt to manage their symptoms with illicit stimulant drugs such as cocaine. This is especially prevalent in those with a family history of drug abuse, suggesting a genetic connection. Typically I've observed that the drug use is indeed a result of poor impulse control and an attempt to return to a state of "normality" by jacking up a dopamine system that may be structurally deficient in some ADD sufferers in the first place (this can indeed be seen in some PET scans).

Methylphenidate, like other ADD drugs, works in a relatively gentle, controlled manner, and relieves symptoms when taken appropriately and at the right dose. Some people try to use illicit drugs as their medication of choice, and the result is often a dangerous and damaging addiction that generates and further exacerbates damage. Of course, heavy stimulant use (such as cocaine, methamphetamine, MDMA, etc) as seen in addiction, causes excitotoxicity to the dopamine system and damages neurons. Thus, many users often try to self-medicate the impulsivity and inattentiveness produced by the substance abuse by taking more of the drug, further precipitating the damage; such is the tragety of addiction.

Fortunately, treatment of ADD usually does improve symptom control, reducing hyperactivity, the need to "act out," the impulsivity that often leads people into trouble, etc. That is why it has been found that with most individuals suffering from ADD, especially those with an underlying predisposition to substance abuse, treatment with methylphenidate reduces the future risk. -Muugokszhiion 22:33, 9 January 2007 (UTC)

study removed from Potential Carcinogen section

The following three sentences have been removed from the Wiki article for the reasons listed below.

"A recent study concluded that human hepatic enzymes have the capacity to convert methylphenidate to a mutagenic metabolite(s) that can induce mutations in exposed lymphocytes. [29] This would explain why tests on rats did not reveal the carcinogenic potential of methylphenidate. Because rats perhaps do not have these enzymes that humans have. Therefore, rats did not develop tumors when methylphenidate was tested on rats".

The link goes to www.toxicology.org/AI/FA/SOT_Toxicologist2006.pdf. The website is hosted by the "The Society of Toxicology". This is not a scientific organization. The folks at ADDF went to great lengths to critic this study and they did a far better job then I ever could. [[1]] The major critism (and there were many) of the article was that it had never been posted in a peer review journal and consequently had no scientific validity. --Scuro 06:39, 31 December 2006 (UTC)

I am removing the study's mentioned in the section now as well as they may not be proper scientific investigations, but they are mentioned here as if they are.--82.69.113.120 00:56, 7 January 2007 (UTC)

Changes

I made several edits chiefly affecting the "Criticisms" section. Many of the purported criticisms were not actually criticisms at all, but rather citations of studies reinforcing methylphenidate's efficacy, tolerability, or safety. So several paragraphs within were moved to other sections.

For instance, "Risk of death" was moved to a new "Long-term effects" section, which is a more appropriate choice, because the risk of death is not necessarily a criticism, but rather a statistical occurrence in susceptible individuals. A "Brain and body" section was created to better house the information on the dopamine system and clastinogenicity. The "Stature" section was also moved to "Long-term effects."

A number of sentences were confusing or incompletely written, so several minor changes were also made to those to facilitate readability and clarify ambiguity. -Muugokszhiion 07:41, 9 January 2007 (UTC)

Muugokszhiion, please explain this reasoning from your recent edit->"acute and chronic adm occur w/ all regular timed med regimens; does not change fact of target receptor system; study provides valuable information re receptor types". The words "acute" and "chronic" in the study refer to long term drug abuse. I fail to see how that sort of drug abuse occurs, "with all regualr timed med regimens". Are you stating that those who take theraputic levels of Ritalin are all drug abusers? I'm lost, that doesn't seem to make sense at all. The second point that you seem to be trying to make is that there is something important going on with the "target receptor system" and receptor types. Look, the study is about chronic and acute drug abuse, plain and simple. This means that the dose was abnormally high and that it was administered over a period of time. Drug abuse has nothing to do with the theraputic use of Ritalin. It's a red herring, the two issues are seperate and do not relate to each other. Why is this in the article? --Scuro 04:33, 10 January 2007 (UTC)

There is nothing political in my edit and I certainly do not believe that people treated with MPH are drug abusers (if I did, I certainly wouldn't be a health professional). I left the study in the article because, upon reading the full text, I couldn't find evidence of 'drug abuse doses' (though it can be difficult to determine what dose constitutes drug abuse in an F-344 rat). Regardless, even if the doses were extremely high, the results still demonstrate which receptor systems were involved in signaling, which may help other users understand how the drug acts on the body, especially if they are already familiar with other stimulants. Like MPH and d-AMP, psilocybin and LSD share a cross-tolerance as well, and one who has never taken psilocybin may be able to conjecture as to the effects or method of action of LSD, with the knowledge of which receptors are involved. While the comparison is not entirely accurate and must be taken with a grain of salt, there are still of course great similarities, many of which can be found to be correct. A further note: the acute effect of a drug is the result of a single dose, and a chronic effect is the result of repeated doses over time. This does not necessarily imply drug abuse, because people who use antidepressants, antipsychotics, blood pressure medication, and so forth, are experiencing the chronic effect of their drug (which is therapeutic).

The bottom line is, while I think the information is valuable, there is already a moderate amount of information in the article regarding the neurochemical patheway involved, and I don't think it's worth fighting over. I'm fine with leaving it out of the article if you prefer. However, I can't help but feel that you were misunderstanding my intention of leaving it in the article: it seems that you thought I was criticising MPH users rather than clarifying the method of action (which is data independent of judgment), and I don't want to make it seem that way. I do not believe that this study represents a bias either way, because I treat it simply as scientific data pertaining to brain signaling, nothing more. Nonetheless, if you prefer to excise the study, feel free to do so. -Muugokszhiion 17:43, 10 January 2007 (UTC)

Glad you responded Muugokszhiion. It nice to have a conversation. Perhaps I simply misunderstood because of the phrasing ie ->"acute and chronic adm occur w/ all regular timed med regimens; does not change fact of target receptor system". As I read that, it indicates that all who take meds, take it over a long time and at a very high dose. Regardless, when I see those two words and it's a rat study, immediatly I think they are examining some facet of addiction. My guess was they were looking to see if abused methylphenidate and/or amphetamine created cross tolerance to cocaine through the target receptors. I'd put money on the fact that these rats probably got huge doses of stimulants for their body size.

Back to the article.

So the effect section was talking about synapses and how Ritalin is a dopamine reuptake inhibitor when WHAMO...we are talking about cross tolerance to cocaine. Why? The ideas don't logically fit together. Nor does theraputic levels of Ritalin have anything to do with cross-tolerance and subtance abuse. And even if it did, what is it doing in this section of the article? I have no problem accepting the idea that cocaine and Ritalin could be working on the same receptor systems, after all they are both stimulants...but then again other noted stimulant like caffine probably also work on those receptors...so what's the point?

So, I wasn't reading into your intentions. All I knew was that this particular sentence did not fit in that paragraph. --Scuro 04:49, 11 January 2007 (UTC)

I belive the study belongs in the article, and I also believe that I can address your concerns. You're not criticising, you simply want more of the facts, so let me explain what I've found upon reading the full text. First, the study was not designed to demonstrate drug addiction, but rather drug tolerance. Second, it doesn't seem that the doses were all at extremely high levels. In fact, the scientists were not only able to establish a maximum tolerable dose, but a threshold dose, the minimal dose required to achieve a response (0.5mg/kg, see PDF file p.2,¶6). In a 150lb human, that is approximately 34mg d-AMP, which is a reasonable dose when taken B.I.D. (most immediate-release psychostimulants for ADD are in fact taken twice a day). I've worked in a number of clinics in which higher doses of Adderall-IR have been prescribed, with generally positive results. Third, the study challenges the notion of "reverse-tolerance" that may occur with d-AMP, and that is an important finding worthy of greater investigation (see p.5,¶1 for mention of norepinephrine sensitization).

In the context of the MPH article, the study does not appear misleading or judgmental. The fact that MPH expresses cross-tolerance with other psychostimulants is important (see p.5,¶3 in Discussion). For instance, it shows that methylphenidate treatment probably should not be augmented with dextroamphetamine treatment, due to the added buildup of tolerance, which would reduce the clinical effectiveness of both drugs, thereby exacerbating the patient's symptoms and increasing side-effects. Not only that, but it also shows that in cocaine users, methylphenidate may be less effective, thus warranting the use of a different medication.

I feel that I've exhausted the subject, but if the study were biased or misrepresentative I, too, would demand its removal. However, I do believe that it is valuable to the article and that its science is sound, and that is why I have spent some time advocating its inclusion. If you're accustomed to science writing, I would encourage you to read the full text if you still have questions regarding the methodology—the researchers themselves can explain their own study far more descriptively than I can theirs. Finally, thanks for being willing to discuss the matter. I wasn't clear enough in my comments on the revert so I really appreciate your patience and thought. -Muugokszhiion 06:44, 11 January 2007 (UTC)

passage should be moved or removed

Lets look at the passage one more time. In the effects section of the article, we have this passage.

"There have also been some medical reports showing a cross-tolerance between cocaine, methylphenidate, amphetamine, which are known to act on similar receptor systems[11]. Pharmacokinetic researchers have found Methylphenidate is absorbed into the body at a much slower rate than cocaine. These researchers concluded that the fact the drug stays in the body for a long period, preventing additional 'highs' until it is absorbed by the body, may prevent addiction.[12] This conclusion is supported by a recent study that found no link between Methylphenidate and later substance abuse.[13]"

The first sentence - speaks to tolerance and addiction. Can you really isolate the two? Without tolerance where is the addiction cycle? This sentence has nothing to do with the section of the article in which is inserted.

The second sentence - is a confusing one in it's context. What are we to draw from it? How was the cocaine and Ritalin administered? Did they take cocaine pills? The point here is that Ritalin has a different delivery system then cocaine which is typically snorted or injected, and that makes all the difference in the world. The slow absorption rate does not create the instantaneous high that snorting or injecting does. With those two methods a large dose of the drug reaches the brain in seconds to create that high and then it leaves as suddenly to create the crash. This is where tolerance comes in and the addiction cycle. Conversely, Ritalin is ingested and slowly absorbed by the stomach lining. The drug gradually builds in the brain and then tappers off. Hence with Ritalin we have no addiction or tolerance.

The third sentence - basically reiterates what I have just stated. Both sentences contrast therapeutic drugs vrs. abusing drugs. Both sentences are not relavant to the passage.

The forth sentence - This conclusion may not be supported by this study. There are many possible reasons that children who take Ritalin may not have an increased rate of substance abuse. The obvious one that comes to mind is that when a student is on Ritalin they may not attract other dysfunctional peers who are drug abusers.

So, this passage definitely doesn't belong where it is now. It may be helpful for drug addicts to know that they shouldn't take Ritalin while using. Perhaps another section in the article should be created and the passage should go there with modifications.

--Scuro 07:19, 12 January 2007 (UTC)

This is going to be a long one, so bear with me. Listen, I don't mean any offense, but I must be perfectly frank with you. From your most recent entry (and the few preceding it), I get the impression that you are very sensitive about how methylphenidate is represented, and you would rather excise immportant facts rather than risk a potential misrepresentation of what your mental image of methylphenidate is. Facts are facts. It seems that you cannot be impartial in this matter, not because you don't want to be, but rather because you do not understand neuropharmacology or scientific publications. Unfortunately, eiter you lack the foundation to be able to read and understand the studies yourself, or you are unwilling to. This is not a fault, it is simply a matter of specialty in life, and science is clearly not your specialty. Let me address your concerns piece by piece:

Sentence 1. Obviously you completely ignored my last post located here. It was not a study of drug addiction, but a study of drug tolerance. Please be able to distinguish the two, and please read my response and follow along. As you don't understand the study, I don't know if I can be any more help than I already have, because if you don't understand the scientific method or research techniques, you won't be able to make sense of the publication.

Sentence 2. You can trust that the research was conducted reproducibly, and that the drugs were administered in the same manner each time (the study has been held up to peer review). It would not be a scientific study without consistency. Also note that the study has been cited by other scientific publications over thirty times. Also see this source for more information. Since you probably won't read it, let me quote some of it for you:

"...methylphenidate (MPH) acts primarily by blocking the dopamine (DA) transporter (DAT) and increasing extracellular DA in the striatum. This is strikingly similar to the mechanism of action of cocaine, a primary stimulant drug of abuse. When administered intravenously, MPH like cocaine has reinforcing effects (euphoria) at doses that exceed a DAT blockade threshold of 60%. When administered orally at clinical doses, the pharmacological effects of MPH also exceed this threshold, but reinforcing effects rarely occur." [2]

What this means is that methylphenidate and cocaine act have very similar effects in the human brain, but methylphenidate use does not typically lead to repeated use like cocaine does. You are correct in asserting that methylphenidate, when used properly, does not typically cause the same kind of addiction as cocaine (this study provides more interesting data).

However, you are completely wrong to believe that tolerance doesn't develop. Almost any drug used frequently causes neurochemical adaptation (drug tolerance). If you knew anything about neuropharmacology, you would know this. This indicates to me that you are not qualified to make the statements you have, possibly for a lack of scientific knowledge. Here are some publications regarding methylphenidate tolerance: Treatment of ADHD when tolerance to methylphenidate develops, Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children, Pharmacodynamic modeling for change of locomotor activity by methylphenidate in rats, Discriminative stimulus effects of caffeine: tolerance and cross-tolerance with methylphenidate, and finally A comparison of the motor-activating effects of acute and chronic exposure to amphetamine and methylphenidate, which states:

"These findings suggest that, although sensitization develops with chronic amphetamine treatment, the consequence of chronic exposure to methylphenidate is tolerance." [emphasis added]

Sentence 3. We have already found that tolerance in a clinical setting has nothing to do with abuse, and that the neurochemical effects of cocaine and methylphenidate are similar. Since your third argument parallels your second argument, I have already addressed it in the above paragraph.

Sentence 4. Of course, there are may reasons why methylphenidate treatment may reduce future addiction in patients, but that is just one finding that scientists have posited, and it is absolutely important, relevant, and has been observed. All of science is theory based on observation and experimentation. Technically, our knowledge of cellular biology is collectively referred to as the cell theory, despite the fact that we know cells exist and we can observe them directly (nobody would reasonably doubt that life is made of cells).

You still make the assumption that a value judgment is implied in a comparison between the effects of methylphenidate and cocaine. That is absolutely not the case. Scientific studies are not there to judge, they are there to supply information. Methylphenidate treatment has helped and continues to help millions of people, and I would never doubt or question the validity of helping people. I have worked under numerous doctors who regularly prescribe MPH to ADD patients, and I have seen how much it has benefitted them. I also have experience treating patients with methylphenidate and have learned a great deal through research, clinical experience, and observation. I have no agenda against the drug at all, so for that very reason I want to represent it farily and impartially.

I have given you a wealth of scientific literature supporting everything I have said, yet I fear that despite my efforts you may not be convinced. Hopefully this won't be the case, and you will understand my points. If not, it would greatly help to have an outside opinion in this issue, especially from someone qualified in neuropharmacology and scientific research. Again, let me reiterate that I am not trying to say anything negative about you or your opinions, I am merely showing that scientific data on the matter says something different. -Muugokszhiion 19:34, 12 January 2007 (UTC)

"From your most recent entry (and the few preceding it), I get the impression that you are very sensitive about how methylphenidate is represented, and you would rather excise immportant facts rather than risk a potential misrepresentation of what your mental image of methylphenidate is. Facts are facts. It seems that you cannot be impartial in this matter, not because you don't want to be, but rather because you do not understand neuropharmacology or scientific publications. Unfortunately, eiter you lack the foundation to be able to read and understand the studies yourself, or you are unwilling to. This is not a fault, it is simply a matter of specialty in life, and science is clearly not your specialty".

Wow, you have subjectively inferred my abilities, intentions, and my interpretations...to begin and frame your response. That speaks volumes. Me thinks you have a greater bias then I. "Facts are facts"? Your scientific abilities come into question also. What researcher would state, "facts are facts"? More later as I chew on the lengthy response. --Scuro 13:00, 13 January 2007 (UTC)

I'd like to butt in here and make a few points that seem to be missing.

Before I do that, however, let me first point out that both Scuro and Muugokszhiion seem to share the goal of accuracy. Since this is my goal as well, I'd like to backtrack a little bit to the original question of the inclusion of specific references.

I'd also like to remind Muugokszhiion that not everyone has access to the full text of every study cited. Abstracts do not contain the information needed to examine methodology. Questioning a study that one has not read is, IMO, reasonable and even necessary. It certainly is difficult to criticize what one is unable to evaluate, however, that does not make the question invalid or the questioner incompetent.

Since this is my first time commenting on a talk page, let me provide a few important pieces of information to consider when reading my posts:

1) I am a scientist by trade. I do not focus on psychopharmacology, but it is not outside my content area. My specialty, however, is scientific research methods.

2) I have not looked into the "wealth of scientific literature" that Muugokszhiion refers to in the above post, but I have scrutinized the Leith & Barrett paper.

3) While I am a skeptic, I am not a cynic. Please to not accuse me of dismissing evidence without examining it; I will not do so without good reason.

4) Like every scientist, I reserve the right to be wrong.

Muugokszhiion: Even with access to the full text, I would never assume that someone having difficulty understanding the Leith & Barrett paper was lacking in scientific understanding. This is a VERY convoluted paper.

It took me 2 hours to get a grasp of what the authors were trying to say and this paper is not long and not outside my area of expertise. The problem? It's very poorly written. The authors use multiple vague terms for all of their important components and the statistical evidence they report does not match the inferences they make. More on that below. These problems do not make for a very readable research report.

Scuro: Your gut is on the right track, but you won't get there by following this path. You are trying to discuss the generalizability (external validity) of work that has no internal validity. That's a bit like trying to fit a hat on the headless horseman. It's mute. Also, the use of terms like "facts" in casual conversation (especially with someone presumed to be a layperson) is usually acceptable. If we don't accept a certain amount of "I know what you really mean", we'd all be walking on eggs everywhere, afraid to open our mouths. I knew a mental health professional once with a stronger-than-average understanding of scientific literature who used the word "prove" quite often. I ignored it because I understood that his definition of "prove" in this context was "there is a great deal of strong evidence to support".

OKAY, back to the work. My opinion:

While this study has a number of serious problems, most are not worth discussing because the lack of internal validity makes this paper worthless. It's silly to discuss whether cross-tolerance in laboratory rats suggests cross-tolerance in humans because there is no evidence here of cross-tolerance in rats. What's more, the inference that cocaine & methylphenidate act on similar receptor systems could not be made using this study even if it were valid (the study, I mean). The authors make a number of VERY VERY serious errors in their reasoning. Their conclusions do not follow from their argument.

I would be happy to provide anyone interested with a pretty long-winded set of notes, but I don't see the point unless someone truly wants to read it. So, I'll only do so by request. The most troublesome problems, however, are: the use of what amounts to a series of one-group pretest/posttest designs. This is the absolute worst type of study one can conduct. It is NOT a true experiment and cannot lead to causal conclusions. In addition, the methods employed in this study do not and cannot provide information to support the hypotheses the researchers set out to test. They make some very serious errors in interpreting their test results.

The authors present sloppy work that is a waste of time, money, and publishing space.

It's relevant, also, to address these comments by Muugokszhiion:

Sentence 2. You can trust that the research was conducted reproducibly, and that the drugs were administered in the same manner each time (the study has been held up to peer review). It would not be a scientific study without consistency. Also note that the study has been cited by other scientific publications over thirty times

These comments would be valid and true in a perfect world, but in the real world this process doesn't fulfill its intentions.

Peer review is a necessary first step in the scrutiny of scientific study, but it does not ensure that research was conducted reproducibly, well, or consistently by any stretch. In fact, I would estimate that at least 50% of the research reports published in respected scientific journals are worthless.

These points are important because an argument based only on authority cannot move forward. Carl Sagan said, "In science, there are no authorities." He meant that heresay and opinion are not evidence. Evidence is in the method and premises, not in whether the report was peer-reviewed.

Science is a body of work completed by scientists. Scientists are, of course, human. Humans are not designed to think critically (for several reasons), and few find this kind of reasoning easy. Like in every profession, mistakes are missed every day and often by many people (sometimes for years) before they are "caught". In addition, like in every profession, a large proportion of scientists are simply BAD at their job.

The result is that one cannot blindly accept that a study published in a peer-reviewed journal is valuable. Peer review is simply the first step in a long series of examinations (including replication) that are needed before a conclusion can be "trusted". I'M NOT KNOCKING SCIENCE. IT'S STILL THE BEST WAY TO UNCOVER KNOWLEDGE. But, we have to be VERY careful about how we go about evaluating it.

You cannot trust that the research is consistent. A quick read of the study shows that there are a number of both vague and direct references to differences in methods among the animals. Given the small sample size, these differences are not trivial. In fact, I am a bit shocked (although I shouldn't be) that Psychopharmacology published this paper. The definition of scientific study is not consistency. Science is simply a systematic way to uncover knowledge and, like everything else, there are "right" ways and "wrong" ways to go about it. While we do not always agree on which methods are best, I can't imagine anyone that truly understands methodology would argue that the methods used here are acceptable. For example, and the thing that REALLY shocks me about this paper, they were somehow allowed to justify their lack of control group with a casual reference to "pilot" work. This is completely unacceptable.

Another important point - Thirty citations in 25 years is nothing to brag about, especially since there's no indication of what those citations involve. I routinely cite studies that are very poor in order to point out methodolical issues. Citations are not the gold standard of a study's value.

The bottom line here is that a statement such as "There have also been some medical reports showing a cross-tolerance between cocaine, methylphenidate, amphetamine, which are known to act on similar receptor systems." requires support AND a clear description of what is meant by "similar". The study cited DOES NOT SUPPORT THIS STATEMENT. Since the rest of the paragraph relies on this statement, I propose that all of the references to tolerance and cross-tolerance be removed.

Barbyma 01:22, 14 January 2007 (UTC)

Thanks for your reply. Based on your discussion of the study, I'd accept the removal of: "There have also been some medical reports showing a cross-tolerance between cocaine, methylphenidate, amphetamine, which are known to act on similar receptor systems," since it appears that the study itself was flawed. -Muugokszhiion 18:03, 14 January 2007 (UTC)

My issue with the study was on a much simpler level. How could inferences be made about the therapeutic effects of Ritalin, based on a rat study where the rats were INJECTED with Ritalin? How can you compare injected dosages per kilogram with a rat and ingested dosages for humans per kilogram? You are comparing apples and oranges and any inferences made from this comparison about the therapeutic use of Ritalin would be bogus. If the authors of the study wanted to look at cross tolerance between the therapeutic use of Ritalin with Cocaine, then they should have used an ingestable form of the drug for the rats. The different delivery system of the drug changes everything. They used to put cocaine in Coca-Cola yet we had no Coke houses. Turn that cocaine into crack which is snorted and the drug becomes highly addictive. The difference in delivery systems is immediate entry ( high then crash ) into the brain vrs gradual entry into the brain. --Scuro 22:13, 15 January 2007 (UTC)

I didn't read everything that was posted here. IV MPH isn't insanely different than oral if you measure the amount in the blood (which people do). I mean, its not the same, but on a similar note not taking an IV study into consideration is almost splitting hairs.

Yes, Cocaine is similar to MPH in the sense that they both effect dopamine. The main difference is that MPH only affects the DAT (dopamine transporter) and keeps it open. This is even different than amphatamine which is assumed to create more DA to be released. What you don't say is that MPH has been shown to be VERY specific in its binding whereas cocaine binds many more receptors. Lastly, and MOST IMPORTANTLY (for those who skim.. like me) after cessation of MPH there was no compensatory increase in the DAT whereas with cocaine there is a large compensatory increase. People on ritalin have a regular amount of DAT and cocaine users have TONS, so without the drug MPH people are fine and cocaine users undergo withdrawl.

Calling MPH cocaine is like calling a VW bug similar to a porsche. I mean, they both are cars and they both drive. But, it is VERY different. Its not just that MPH is slower, its the fact its DIFFERENT. The "reward response" for taking a dose is very different - yet the stimulatory effect is similar. The specificity of the drug is why its so different. Cocaine is a lot more general and effects serotonin and much more. I mean, seriously. Look at a kid or adult on ritalin and take it away from them, or see the lengths they go to to get their hands on it. Then compare that to a cocaine addict. I know my last point isn't a scientific study so don't harp on me for saying it. I made much better points.

If someone is actually interested in learning about the drug and wants to read a scientific paper read the one I site below (I posted about GH also, its where I got all the above info). Its much better than most of the crap out there about ritalin. There are MANY worse drugs out there that are much more dangerous. Anybody who says it is a bad horrible drug is just misinformed and needs to read the literature themselves rather than listen to what a celebrity or nightime news stations says to get people to listen to them. Rjkd12 02:17, 20 January 2007 (UTC)

Growth Hormone?

I was reading up on the scientific literature about methypheindate and came to the conclusion that ritalin increases growth hormone levels. Joyce et al (1986) and Brown (1977) both show an increase in serum levels of GH with MPH, with a larger increase in males compared to females. I assume this literature is up to date considering a recent review of the drug (Leonard 2004) cites these studies and also concludes (after "reviewing all the literature" that methylphenidate does in fact increase GH output.

So, why after googling ritalin and GH I get people touting like mad that it DECREASES GH output and that it is a concern for growing children? Also, if it does increase GH, any hypothesis about why it may stunt the stature of a growing person? Rjkd12 23:40, 16 January 2007 (UTC)

Scientology and Anti-Psychiatry criticism of Ritalin

When it comes to Ritalin both movements have been highly vocal and have played a major role in the public's perception of the drug. Consequently it is appropriate to accurately discuss each entities viewpoint in this article and compare them to each other. With regards to Ritalin and Psychiatrists there appears to be little difference in opinion between the two groups.

80.109.194.224 decided to edit the section stating that" Nevertheless Scientologists, unlike others do view "hyperactivity" as a problem, that needs treatment (they advocate a change of diet, so their "solution" is also chemical in the broad sense of the word)". Yet Breggin who is an Anti-psych offers the same solution in his Ritalin Fact book in "chapter 11 entitled "do alternative treatments help with ADHD?". This is the part of the anti-psych and Scientology viewpoint that appears to be illogical. On the one hand they can state that ADHD is bogus, a fraud, a collection of symptoms...yet on the other hand they offer solutions to this "nonexistent" problem. ADHD skeptics come up with discriptive terms like "wildcolts" or describe the behaviour as "boys being boys". But if this is normal behaviour why do they need fish oil, magnesium, or some other "catalyst" to change behaviour?

Both the CCHR and Scientology believe the disorder is bogus. Both offer alternative solutions to hyperactive behaviour. For this reason I am reverting the section back to it's original format which correctly makes note of this. --Scuro 13:46, 20 January 2007 (UTC)

Here is another tortured edit from 80.109.194.224. "Nevertheless Scientologists, unlike others do view "hyperactivity" as a problem, that needs treatment (they advocate a change of diet, so their "solution" is also chemical in the broad sense of the word) (Breggin also advocates a change in diet against "hyperactivity", so his viewpoint is similar in this respect)". So I take it that they and different but the same?

Isn't this passage so much cleaner and closer to the truth? -> "The viewpoint of Baughman and Breggin with regard to Ritalin is almost identical to the CCHR's viewpoint on this issue". Readers need to know that. If they are looking for a critic of Ritalin, and the CCHR and Breggin have the same viewpoint, why research both? The statement gives information and while it is a generalization, I wait to see any example where the two parties differ in opinion with regards to ADHD and Ritalin. The generalization has not been challenged with facts.

I can be wrong user 80.109.194.224. But take the time to point out to me errors in this information, instead of deleting out my contributions without sufficient justification. If not I will simply have to contact an administrator.

--Scuro 18:00, 20 January 2007 (UTC)

Odd phrasing

"It is also important to note that while ADHD is a condition that includes hyperactivity, problems holding still, and following directions, this is also typical of a child under the age of 6. This causes difficulty in diagnosing children under this age and should probably not be studied." -- I had assumed that this was vandalism, but took a quick look at the page history and apparently it isn't. Therefore: What is this supposed to mean? Can we phrase this more clearly? -- 201.50.248.179 20:13, 28 January 2007 (UTC)

I am not sure, but I'll give my 2 cents. Maybe instead of should not be studied, it should say, "This causes difficulty in diagnosing children under this age and therefore should not be used as critera in diagnosing someone with ADHD." Or elude to how it can cause a false positive diagnosis in children under the age of 6. And, are children only hyperactive until 6? That seems like a young age, especially for boys. Rjkd12 20:30, 28 January 2007 (UTC)

Side Effects And Effects Like Other Psychomotor Stimulants?

Does methylphenidate produce similar effects as other psychomotor stimulants? Since methylphenidate is a psychomotor stimulant, doesn't it have side effects very similar to that of cocaine and the amphetamines? Coke and amphetamines such as meth cause similar side effects and are equally as addicting. Since all three are closely related I assume they produce very similar effects and side effects. If this is so, wouldn't it be just as dangerous to use methylphenidate as any other psychomotor stimulant? It doesn't seem like coke or meth has as much medical uses as this drug though. Zachorious 13:01, 1 February 2007 (UTC)

It's all in the delivery system. Snort or inject stimulants and pow, instant high and then major crash. The therapeutic level of stimulants used in Ritalin are ingested. These meds have been shown to be one of the safest and most effective classes of drugs when taken as prescribed. --scuro 05:24, 9 March 2007 (UTC)

Effects

Holy heck, I had no idea there was going to be so much talk. I'm sure my little comment will get lost in the crowd. Under "effects", the article states "It is claimed to have a 'calming' effect on many children who have ADHD,[9]". The article cited is not specifically referencing methylphenidate. If this is a statement on CNS stimulants in general, maybe the comment should be on a CNS stimulants page. If it is about MPH specifically, then a different source should be cited. I'm not taking issue with the statement, merely how it is supported. If I knew how to fix it I would.

The Letter J 04:28, 9 March 2007 (UTC)

I agree, the content of the reference was misrepresented. Removed the reference from the article; here it is if someone thinks of a way to re-integrate it:

<ref>{{cite web |url=http://psychiatry.jwatch.org/cgi/content/full/1999/301/1 |title=Hyperactivity Paradox Resolved? |accessdate=2006-11-11 |work=Journal Watch }}</ref>

I'll put the ref at Talk:Attention-deficit hyperactivity disorder and Talk:Stimulant as well for use in those articles.--Eloil 22:01, 27 March 2007 (UTC)

Is a citation *really* needed when listing tachycardia as common side-effect of a CNS stimulant? Really? Is there a doctor in the house?

Yes a Dr. would be nice, ignorance can show it's face anywhere. THERAPUTIC levels of stimulants do not cause the same side effects as stimulants that are abused. For instance, coffee is a CNS stimulant and can cause a rapid beating of the heart. Yet if you stay under a certain level it won't have that side effect for the vast majority of drinkers. For instance, if you started at a quarter cup of coffee and then the next week raised it to a 1/2 a cup of coffee, that side effect would not be seen in a significant population of the controls. In fact you would see positive attributes from consumption. Same holds true for theraputic levels of stimulants.--scuro 21:49, 4 April 2007 (UTC)

Similarity to Cocaine

Look, hell, I take Concerta (legitimately) and even I know that it's both structurally and functionally similar to Cocaine. I really do think that should be expanded on, and IIRC there used to be a section on it. Where'd it go? Klosterdev 16:26, 2 April 2007 (UTC)

I don't think it's responsible or appropriate to compare the subjective effects of methylphenidate to cocaine in this article. The two drugs have a similar receptor profile, which might be worth mentioning, but even then, this article is about MPH, not cocaine. Furthermore, cocaine and MPH are not structurally similar. MPH is a substituted phenethylamine while cocaine is much more similar to tropane. -Muugokszhiion 00:05, 3 April 2007 (UTC)

I agree whole heartedly with Mugg...to top it off one drug is abused the other is therapeutic and they have two TOTALLY different delivery systems. One having potentially disastrous outcomes while the other is clinically proven to improve symptoms for 9/10ths of the users. This a red herring idea . --scuro 03:04, 3 April 2007 (UTC)

This whole talk section reads strangely, with one side actively pursuing anecdotal "this one time at band camp I took Ritalin and I died" and the other side begging for a decent article with references to solid sources. Is there an adequate set of criteria for "structurally similar" that could clarify this? It seems like people are looking at molecular diagrams and returning to the argument with, "yeah, but the hexagon in this diagram and the hexagon in this diagram are really similar." I applaud Muugokszhiion's patience. —The preceding unsigned comment was added by 74.114.221.41 (talk) 17:02, 4 April 2007 (UTC).

IIRC, people with ADHD have a higher tendency to abuse cocaine due to it having similar effects as Ritalin. Am I missing something else? Klosterdev 02:33, 4 April 2007 (UTC)

Scuro's characterization of cocaine as solely a drug of abuse is factually unsound - The difference between Schedule I & II drugs is a recognized medical purpose. MPT, cocaine & methamphetamine are all Schedule II and they are indisputably related to each other either by pharmacology or use in disorder therapy. To deliberately redact this information based on moral judgements of appropriate use seems subjective and not NPOV. GregoryCJohnson 23:08, 27 April 2007 (UTC)-

Cocaine is a stimulant and they have some similarities. How closely are they related? Someone else could give you a better answer. Now imagine if someone took a very small dose of cocaine and instead of snorting it or smoking it, they ingested the drug. I'd hazard to guess that those with ADHD may see some positive outcomes with their symptoms. And conversely if you took the caffeine from coffee beans and refined it into a pure substance and then injected it, it would be highly harmful over time.

But why bring up the question? ...and the answer is simply to make the association in this readers mind. For some people it's not about the truth but rather about trying to get people to accept their belief system. It's not like they will enlighten you with knowledge but rather they will attempt to influence you to create a bias in you. Anyone who knows anything about this subject sees this as a non-issue. That is because it is an apples and oranges comparison. One stimulant is abused and instantly reaches the brain. The purpose is to get high and the drug reaches it's maximum effect almost instantly. The downside to drug abuse is the crash and possible addiction. On the other hand, theraputic stimulants are taken at a very small dose that has been tested to clinically reduce symptoms in over 90% of those who have ADHD. The dose is swallowed and slowly enters the bloodstream through the stomach. There is no withdrawal or addiction.

This issue is all about creating "smoke" and confusion in your mind. --scuro 22:26, 4 April 2007 (UTC)

Gentlemen, I don't mean to be combative, but your position here simply untenable - Studies dating back to at least 1995 show identical receptor binding and posit clearance time differentials proportional to abuse potential. The link may not be proven, but it cannot be credibly dismissed out of hand. GregoryCJohnson 23:08, 27 April 2007 (UTC)

Heck the effects are damn alike those of caffeine as well. But I neither see the need to post something like that, as it would have very little (if any) informative value.(And in my opinion it sounds like a very bad idea to make such comparisons until more can be proven?) "the non registered one" (Ill be registered again soon do not start whining eh?)

[I don't again have my papers on this computer to reference but I have seen that rats will substitute methylphenidate for cocaine. This is surely not in debate. They are pharmacologically similar in action and though as a chemist I agree that cocaine is very structurally different that is irrelevant in this case - the end effect is very similar due to a very similar mode of action - thus I would give it to the pharmacists on this one that they are closely related drugs, even if not so closely related molecules. The method of delivery for cocaine is generally different, but both can be taken in the same ways - you just don't take methylphenidate by insufflation when using legitimately because it is a faster absorbance profile - and thus more akin to cocaine consumption. Anecdotally I have to say that a leading UK specialist I saw asked me (after all the other doctors, including an assisstant of his had asked the "Have you ever taken an illegal substance?" question) if I had ever tried cocaine as many patients of his who have ADD or ADHD say they found it calmed them down. Thus the close tie is strongly regarded by leading professionals - to deny this is wrong - whether you think it is an inconvenient truth for sceptics to take up it is still a truth when left undistorted.] [Sorry. Not sure how to indent.] [Oh and MPH is - as much as I dislike the fact as a pro-MPH legitimate user - addictive and has withdrawal effects (see my Titre discussion below)]

i am willing to ignor the pointless endevers to cover ones footsteaps, if there is proof that rats lprefer heroin to methile phenidate its because any one woud prefer it to methyle phenidate. cocane gets you high and what not. gives you a much more joyous experience than ritalin which makes you more atentive in lessons. its like wich do you prefer? boring old house or mansion. cocain has extreemly bad side effects, in all users. ritalin has moderatly mild side effects in some cases. and in a few cases serious effects (usualy linked with either inconsistant dosage, continuous overdose, abuse) but moastly only mild side effects as the body ajusts to the drug. the diference is, one is a massively ileagle drug that would never be prescribed by a responsible doctor and the other. is a perfectly leagle prescription drug that is prescribed to manny. (i do agree sometimes a little too many but thats another discusion) the symilarity between the two is that they are stimulants, if they both have hexagons then they are structuraly symilar to an infinate number of other chemical compounds that can be ingested or indeed naturaly occor in the body. one slight change in the persition of the active groups can drematicaly chainge the effects of the molecule. if you wanna prove me rong tell me that phenol and tnt have symilar properties because they have an aromatic ring in them. —Preceding unsigned comment added by 144.82.218.235 (talk) 03:58, 16 January 2008 (UTC)

Addiction Study

The beginning of the Addiction section mentions a study in which MPH users have a higher tendency to use cocaine 'at least once' in their lifetime. I think this belongs in another section; Someone's willingness to experiment with new drugs is separate from their ability to get addicted to them. If there's a study which shows that MPH users become addicted more quickly, that would be more appropriate. GarconDansLeNoir 19:06, 3 April 2007 (UTC)

chop chop

The criticism section was taking over the article. The information within this section is neither majority viewpoint or minority viewpoint. It is controversial and as such was moved to the ADHD controversy article. --scuro 04:33, 9 April 2007 (UTC)

There are no negative sides to giving amphetamines to children

Military looks to drugs for battle readiness As combat flights get longer, pilot use of amphetamines grows, as do side effects.

By Brad Knickerbocker | Staff writer of The Christian Science Monitor

When Navy fighter pilot "Maverick" and his sidekick "Goose" declare "I feel the need – the need for speed!" in the box-office hit "Top Gun," they're speaking about the capabilities of their fast and furious F-14 Tomcat. In the air war over Afghanistan, "the need for speed" may have taken on quite a different meaning.

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"Speed" is the well-known nickname for amphetamines, the controversial and potentially harmful drug some American pilots are taking in order to enhance their performance. Despite the possibility of addiction and potential side effects that include hypertension and depression, such drugs are needed, military officials believe, in order to stay alert and focused – especially on long-range bombing missions. Such flights can mean nine hours or more alone in expensive, high-performance aircraft. Their lethal weapons are aimed at an elusive enemy that can be (and has been) confused with civilians or friendly troops.

According to military sources, the use of such drugs (commonly Dexedrine) is part of a cycle that includes the amphetamines to fight fatigue, and then sedatives to induce sleep between missions. Pilots call them "go pills" and "no-go pills." For most Air Force pilots in the Gulf War (and nearly all pilots in some squadrons), this was the pattern as well.

The drugs are legal, and pilots are not required to take them – although their careers may suffer if they refuse.

Amphetamines follow a pattern that goes back at least 40 years to the early days of the Vietnam War – further back if one counts strong military coffee as a stimulant. But they're also part of a new trend that foresees "performance enhancements" designed to produce "iron bodied and iron willed personnel," as outlined in one document of the US Special Operations Command, which oversees the elite special-operations troops that are part of all the military services.

Indeed, the ability to keep fighting for days at a time without normal periods of rest, to perform in ways that may seem almost superhuman (at least well beyond the level of most people in today's armed services), is seen by military officials as the key to success in future conflicts.

"The capability to resist the mental and physiological effects of sleep deprivation will fundamentally change current military concepts of 'operational tempo' and contemporary orders of battle for the military services," states a document from the Pentagon's Defense Advanced Research Projects Agency (DARPA). "In short, the capability to operate effectively, without sleep, is no less than a 21st Century revolution in military affairs that results in operational dominance across the whole range of potential U.S. military employments."

A 'radical approach'

What's called for, according to DARPA, is a "radical approach" to achieve "continuous assisted performance" for up to seven days. This would actually involve much more than the "linear, incremental and ... limited" approaches of stimulants like caffeine and amphetamines.

"Futurists say that if anything's going to happen in the way of leaps in technology, it'll be in the field of medicine," says retired Rear Adm. Stephen Baker, the Navy's former chief of operational testing and evaluation, who is now at the Center for Defense Information in Washington. "This 'better warrior through chemistry' field is being looked at very closely," says Admiral Baker, whose career includes more than 1,000 aircraft-carrier landings as a naval aviator. "It's part of the research going on that is very aggressive and wide open."

In a memo outlining technology objectives, the US Special Operations Command notes that the special-forces "operator" of the future can expect to rely on "ergogenic substances" (such as drugs used by some athletes) "to manage environmental and mentally induced stress and to enhance the strength and aerobic endurance of the operator."

The memo continues: "Other physiological enhancements might include ways to overcome sleep deprivation, ways to adjust the circadian rhythms to reduce jet lag, as well as ways to significantly reduce high altitude/under water acclimatization time by the use of blood doping or other methods."

Although the Air Force Surgeon General's office recently acknowledged that "prescribed drugs are sometimes made available to counter the effects of fatigue," it is not publicly known how widespread the practice is or whether special-operations forces on the ground in Afghanistan are taking such drugs.

But it is certainly widely talked about among combat veterans and military experts.

"Given the extent of recreational drug use within the military, and the use of performance-enhancing drugs among athletes, it is very easy to imagine that warriors would consider using any manner of drug they thought would increase their chance of returning home alive," says John Pike, a defense expert with GlobalSecurity.org in Alexandria, Va.

During the Gulf War, according to one military study, "pilots quickly learned the characteristics of the stimulant [Dexedrine] and used it efficiently." Pilots were issued the pills and took them if and when they felt the need.

Some people have defended that practice. "If you can't trust them with the medication, then you can't trust them with a $50 million airplane to try and kill someone," says one squadron commander whose unit had the fewest pilots but flew more hours and shot down more Iraqi MIGs than any other squadron.

But military officials, as well as medical experts, warn that the use of amphetamines can clearly have its bad side.

The flight surgeon's guide to "Performance Maintenance During Continuous Flight Operations" (written by the Naval Aerospace Medical Research Laboratory in Pensacola, Fla.) mentions such possible side effects as euphoria, depression, hypertension, and addiction. There's also the possibility of "idiosyncratic reactions" (amphetamines can be associated with feelings of aggression and paranoia) as well as getting hooked on the "cyclic use of a stimulant/sedative combination."

"The risk of drug accumulation from repetitive dosing warrants serious consideration," the guide notes. The "informed consent" form that military pilots must sign notes that "the US Food and Drug Administration has not approved the use of Dexedrine to manage fatigue."

Amnesia on the job?

It's not just the "go pills" that can cause problems in certain individuals. "No-go pills," used to induce sleep, can have dangerous side effects as well – including the possibility of what's called "anterograde amnesia ... amnesia of events during the time the medication has an effect."

"For the military aviator, this raises the possibility of taking the medication, going to a brief, taking off, and then not remembering what he was told to do," according to the lab's report.

But researchers say suchsymptoms "are primarily dose related and are not expected with 5-10 mgs of dextro-amphetamine (Dexedrine)" – the amounts given to pilots in the Gulf War and in Afghanistan.

For the most part, the issue of prescribed drug use by US pilots has gone unreported in the United States. But in England and Canada, it has been raised recently – especially in a possible connection with errant bombings.

In April, four Canadian soldiers were killed and another eight injured when an American F-16 pilot on a long-range mission, thinking he was under attack, dropped a 500-pound laser-guided bomb on an allied military exercise.

"The initial version of the Canadian incident portrayed the pilot as behaving with inexplicable aggression tinged with paranoia, and my first thought was that the poor guy had been eating too much speed," says Mr. Pike of GlobalSecurity.org. Officials are still investigating that accident, and the pilot has been questioned, among other things, about the possibility of drug use.

More recently, concerns have been raised about aggression and violence among soldiers returning from Afghanistan. In three of four cases in which men killed their wives, the accused husbands were in special-forces units based at Fort Bragg, N.C.

"It is quite obvious that someone needs to pose this question in the context of the business at Fort Bragg," says Pike. "This sort of hyper-aggressive behavior is just what one would associate with excessive use of such drugs or from withdrawal from using them."

As the US moves into an era in which national security is likely to mean wars fought from the air – using attack aircraft and small, specially trained units flown long distances to the battlefield – the issue of performance-enhancing drug use by US military personnel is likely to escalate. "The real story here is the ever-extending reach of air power," says Daniel Goure, a military specialist at the Lexington Institute in Arlington, Va. "We were flying F-15s out of Lakeheath [a Royal Air Force base] in the United Kingdom during Kosovo. Why? Because we had used up the available landing space everywhere else."

"As asymmetric threats such as ballistic missiles become more available to our adversaries, we are going to stand even farther back," adds Dr. Goure. "That means that this problem [i.e., the need to combat pilot fatigue] can only grow." —The preceding unsigned comment was added by 70.189.0.225 (talk) 04:42, 18 April 2007 (UTC).

...and the point of the cut and paste antipsych article and totally unrelated title is ....? --scuro 10:51, 18 April 2007 (UTC)

How about removing this? Just asking... "the non registered one" (soon to be)

Criticism of Methylphenidate based on relation to taboo drugs, specifically cocaine & methamphetamine

Scuro,

I apologize for the inconvenience of having to revert my addition, especially one characterized as a "rambling collection of facts, and ideas not related to the topic". I was trying to formulate a concise, accessible description of the underlying basis of MPT criticisms. The only apparent distinguishing criticism consistent with a section linking to "ADHD controversy" is the belief that MPT use is equivalent to cocaine/methamphetamine abuse. I attempted to define the scope of the discussion, exclude ADHD related criticisms, and state the summary of my analysis. After defining the structural concerns and the mechanisms thereof, I address them in relation to both comparative drugs with particular attention to maintaining NPOV.

Could you please detail the basis for your characterization?

Thanks, GregoryCJohnson 23:21, 27 April 2007 (UTC)

Methylphenidate (MPT) is a CNS stimulant with broad and controversial distribution, as are cocaine and methamphetamine. All three are "Schedule II" drugs, all three are considered "medically useful". Your paediatrician could prescribe any of them, including cocaine and methamphetamine. All three act primarily on dopamine, but so do food, sex, and most other things, as discussed extensively under that entry,

Leaving aside the emotionally charged issue of medicating children to treat a vaguely defined condition (ADHD), the considerations are mainly the chance of abuse, dependence, and injury. The first is a moral issue, the second societal, while the third is self preservation. As regards MPT, it either ties or compares quite favorably to both cocaine and methamphetamine. This is not an accident, but rather it is the reason MPT is used.

Unfortunately, elevated levels of anything with a receptor can cause downregulation, wherein the receptor's sensitivity decreases. This risk of downregulation exists with any elevation, regardless of how elevation is achieved, and increases with exposure. A common example of downregulation is diabetes. High carbohydrate intake increases insulin levels, which can damage insulin receptors, leading to diabetes, possibly requiring injecting supplemental insulin for life. It is not unreasonable to say obecity-induced diabetes is just another form of drug addiction

Turning strictly to neurotransmitters, how you achieve increased levels is important. Increased levels can result from either reuptake inhibitors or agonists. Inhibitors stop the destruction of the neurotransmitter, while agonists actively release any available neurotransmitter they affect. Using a bathtub analogy, inhibitors close the drain while agonists turn the hot water on full blast. Eventually you will either run out of hot water (dopamine) or overflow the tub (receptors).

MPT is a very poor substitute for cocaine - both are dopamine reuptake inhibitors, but cocaine is a dopamine agonist as well. The "high" from increased dopamine is more related to the speed than the amount of increase. A inhibiting agonist increases it's effect by flooding the brain faster with more dopamine, thus depleting the dopamine reserve. Further, cocaine is short acting, clearing from the receptors in about 20 minutes. Fast clearance means frequent cycles leading to rapid exhaustion. In contrast, MPT clears in about 90 minutes without affecting dopamine reserves - too long and too low for an abuser.

Turning to methamphetamine, it is a truly powerful drug - like cocaine it is an inhibiting agonist, but in addition to dopamine it targets norepinephrine and seratonin as well. It's clearance rate is nearly half a day, making it substantially more powerful on an equal weight basis, giving it longer effect but still depleting three neurotransmitters in the end. Unlike cocaine, in 2007 methamphetamine still used to treat ADHD, among other things. (See Desoxyn) For various reasons it is usually used after the other treatments are shown to be ineffective.

In conclusion, as the toxicologists point out, "the dose make the poison", thus the debate eventually resolves to the question of physician judgment in the selection of drugs. All three are clearly powerful drugs, but even methamphetamine is clinically useful in limited situations and at appropriate doses.

Gregory,

Don't apologize.

You wouldn't have taken the effort you did to post unless you have something important to say. For improvements I'd recommend either creating a new article entitled, "Criticism of Methylphenidate" and linking it back to this article or I'd find ways to integrate your ideas into the article. If you choose the second option, start with the what you feel are the most important and most obvious points. Make sure that the ideas inserted into the article in such a way that they don't interfere with the flow. Be clear and concise and above all cite your ideas...especially those ideas that stray from the majority viewpoint.

Personally I'd want to know if you are making reference to the therapeutic effects of the drug or drug abuse.--scuro 03:00, 28 April 2007 (UTC)

Recrational Uses Miss Leading.

Ridalin is NOT Speed, or Uppers or any of those things. Speed is usually a mix of several weak stimulants that causes nervousness and euphoria, Ridalin is just Ridalin, Adderal is commonly know as Speed. And don't quote me on this but I've read somewhere that snorting Ridalin is becoming less common because of its extreme effects when snorted. —The preceding unsigned comment was added by 70.177.220.1 (talk) 00:29, 1 May 2007 (UTC).

Methylphenidate is a stimulant and is used as one. Btd-no 01:41, 1 May 2007 (UTC)

Uh, yea several anecdotal reports on Erowid.org mention snorted or injected methylphenidate to induce a very euphoric state of stimulation, comparable to and (in some reports) exceeding that of cocaine. The recreational use information is NOT misleading. Methylphenidate is a stimulant of the dopamine reuptake inhibtor class (as is cocaine) and therefore it's potentially powerful psychoactive effects when consumed in a recreational matter SHOULD NOT be ignored, downplayed, or overlooked. —Preceding unsigned comment added by Metalhead1994 (talk • contribs) 21:42, 22 July 2008 (UTC)

Comparison to Cocaine

I don't understand the controversy here. I posted about this higher up, and it didn't seem to be recognized. Just because two drugs are similar doesn't make them the same. Cocaine is not only a dopamine reuptake inhibitor, its a dopamine agonist - and a very fast acting one at that. MPH is only a dopamine reuptake inhibitor that is localized to a certain part of the brain. Because of its relatively mild effects and its specificity it is nowhere nearly as potent as cocaine. If it was, we'd have MPH junkies like we have crack heads and that obviously isn't true. Morphine is VERY similar to opium, and we do have both morphine and opium addicts. Look at oxycontin and heroine, both very similar and we have addicts of both. You see some students selling ritalin, and you see some snorting it, but its not an epidemic like the other drugs I mentioned. Two main things separate it from other stimulants. One is, it doesn't appear to give the 'reward response' that is so addicting. Even adderal gives that response more than MPH, and cocaine and meth give that response a lot, hence their addiction. Also, (FOR THOSE SKIMMING, READ THIS) a study on rats showed that there was no upregulation of the dopamine transporter after cessation of heavy IV MPH administration, meaning there was no compensation which would give withdrawal upon discontinuation of the drug. Part of the reason cocaine is so addicting is that when you are off it you have a ton of empty dopamine receptors (which are highly upregulated) and the cells don't have any to release, so you get very depressed. Plus, IIRC regarding future drug use, it was kids on ritalin who had less future drug use due being more accepted in school and doing better grade-wise.

With the main drugs out there (cocaine, opium, heroine etc) science has had a difficult time to extract the good things from them (stimulation, relaxation/anti-anxiety, pain relieving) and get rid of the addictive and "bad" qualities. Sometimes it works to a degree (vicodin, xanax, MPH, dextroamphetamine) and other times not as well (oxycontin, morphine, methadone). This drug has been around since the 60's and at one point was even in some european multivitamins, which is indicative of how well tolerated it is.

This is point of view, but out of all the stuff that is out there, this is one of the most mild and well tolerated drugs around. I'd prefer my kid pop MPH over alcohol, pot, even aspirin. Granted, kids can crush the extended release tablets or snort it, but obviously that isn't as "good" as other drugs or like I said we'd have more of a demand on the street for it. As far as pharmaceuticals that have a negative effect on the public, there are MUCH bigger fish to fry and much better ways to spend you internet searching.Rjkd12 22:03, 23 May 2007 (UTC)

[Heroin is much more "powerful" than morphine, and in turn codeine etc. etc. They are natural drugs or derivatives produced due to the massive increase in desired activity/utility (when used legally or otherwise). MPH is not available like cocaine as it is a full synthetic (or as close as from what I have seen). To make it would take much more effort for a non-chemist than getting hold of cocaine instead to abuse. It would involve several synthetic steps from some interesting starting materials that I doubt you can just buy as an individual, especially given the last few years of anti-terrorism crackdowns limiting even some legitimate chemical purchases. At the end you would have something very close to cocaine when snorted, though maybe not quite as "good".

Thus: Why bother? If you want an illegal high it is easier to get cocaine. This is a chemical/natural product sourcing difference and nothing to do with the drug effects. And people abuse codeine, even though it isn't as "good", so it is more down to availiability. Even MPH is abused by insufflation or injection - the delivery method is not determined by the molecule - cocaine could be taken orally (I believe - I don't think it will be destroyed).

Also crack and cocaine are different - you say we would have MPH-junkies; well we have cocaine addicts seperate to crack addicts - they are different drugs. What it was in is irrelevant - cocaine was in coca-cola at one time. Elemental phosphorus was in health tonics. Dextro-rotatory amphetamine doesn't have bad qualities 'cos science made it that way?! (Though I realise you qualified this somewhat, but methadone has pros surely, and amphetamine cons.)

I agree that MPH ranks low in the recent Lancet article about 20 drugs of abuse and their real impact (D. Nutt, et al., about March 2007) and there are bigger fish to fry but the truth should be stated, bias can come from either side.]

164.107.238.46 (talk) 21:54, 18 April 2008 (UTC) 18 April 2008

I don't mean to be picky but Morphine comes from Opium so you shouldn't say it's very similar b/c Morphine along with Codeine are in Opium. They have very similar effects because they are opiates. All opiates and opioids have the same effects but have different potencies and efficacies. And no duh that Oxycontin and heroin are similar, heroin is derived from Morphine, and Oxycontin is another Opioid, which I believe is derived from thebane which is also found in opium. All Opioids have pretty much the same effects. Also Crack and Cocaine are pretty much the same thing, Crack is Cocaine but in the Free Base form while Cocaine is the Hydrochloride form, one is more volatile and one is more water soluble they are the same drug in different forms, like crystal sugar and powdered sugar, they are the same thing in different forms. I have no idea why you are even bringing this up because Ritalin is an amphetamine and Cocaine is not (and on top of this you are discussing opioids). While they are both stimulants they aren't the same thing. Ritalin has a mechanism like that of cocaine but it is an amphetamine. Cocaine and amphetamines are very similar in effects except that Cocaine has a local anesthetic effect and causes paranoid psychosis, and being an amphetamine i don't think ritalin has these effects but i don't really know. Anyway i have no idea what your point is supposed to be here i just felt that some of your statements needed to be corrected.

New pic from article "phenidate"

Focalin

The article "phenidate" contains little information pertaining to methylphenidate. In fact, it only mentions ADHD. It has a good rotating pic though. I've turned it into a redirect to this article. Fuzzform 23:36, 1 June 2007 (UTC)

Um... nice! Should be on the front if you ask me (the rotating pic at least) Then again I guess style and methylphenidate does not match. (not that the choice is mine to make just wanted to comment on this rather nice rotating pic) "the non registered one"

You might want to read this discussion from the Wikiproject on chemistry where most people decided that they don't want rotating images of molecules in articles.

Although it's not an official policy, it is the de facto guideline that chemists on Wikipedia tend to follow.

Ben 15:53, 9 July 2007 (UTC)

Inappropriate Footnotes

Just thought I'd mention that I removed four footnotes from the main article that seemed to have merely been tacked on to promote a controversial viewpoint, not to further the article. They were the last four footnotes listed, and unlike all the other footnotes none of these were referenced within the article. All of them pointed to sites with pronounced anti-methylphenidate viewpoints claiming that the medication is dangerous and leads to brain damage. The questionable validity of the claims made in the referenced articles seems somewhat besides the point - my main reason for removing them was that they seemed more relevant to the Controversy_about_ADHD article, and that their presence seemed intended mainly to inject an inappropriately strong POV into this article. Anyone have any qualms with the removal? -- 01:57, 12 June 2007 (UTC)

None here... "The non registered one"

Is it possible that Ritalin does not work on everybody suffering ADHD?

Or is this a sign of wrong diagnosed ADHD? Are there people with ADHD not responding on Ritalin but on Amphetamine? Thank you for your answer. --134.155.99.41 14:45, 24 June 2007 (UTC)

The short answer is yes to q#1, possibly for q#2, and yes to q#3. --scuro 03:35, 25 June 2007 (UTC)

Thank you for your answer. Too bad that amphetamine is forbidden in Germany so I have to keep on suffering from ADHD. --134.155.99.41 02:15, 26 June 2007 (UTC)

Germany has blinders on, they are backwards when it comes to a general understanding of disorders and how to treat them. --scuro 03:59, 26 June 2007 (UTC)

That's true. Weird they don't have any inhibitions prescribing downers but are very biased against amphetamines. Double weird as Germany invented amphetamines! Maybe it has something to do with the fact that in Nazi Germany the Wehrmacht gave soldiers amphetamines? And it seems to me typical for the mentality of Germans, even German doctors to look rather after the law than after how to help. --134.155.99.41 15:25, 27 June 2007 (UTC)

I believe that most if not all medications can fail to provide the desired effect at less than way too rare cases. The mentality of Germans? why does that sound so... discriminating? Well one thing is for sure. That is no fact and contains no informative value whatsoever. "The non registered one"

This isn't the only drug possible to use as treatment. New options include modafinil, and better yet, atomoxetine --user:guruclef —Preceding unsigned comment added by 200.7.17.84 (talk) 01:56, 28 September 2007 (UTC)

Taper/Titration of Dosage

Apologies for not having yet created an account; though I hope the credibility of this point is self-evident.

I have seen no reference to any mention of beginning/ceasing MPH medications. Anecdotally I have seen (generally) US ADHD-support sites that make reference to the ability to use these medications on “only the days you feel you need them” (Not a true quote; I have not currently got the URL's noted for this information).

However from experience of the UK system, and specialist psychopharmacology documents such as http://jop.sagepub.com/cgi/content/abstract/21/1/10 (DOI: 10.1177/0269881106073219; which mentions titrated doses - though at this moment I am unable to access the reference which it specifies contains some mention of this material), I can say that it seems to be the practice in the UK that doses are usually (?) titred up/down so that the body has time to become used to the changes in dopamine metabolism/concentrations (whether they also be up or down).

Given the "interesting" issues raised above by at least one un-logged individual, that the removal abruptly of methylphenidate treatments is physiologically stressful (although the degree mentioned is somewhat questionable) I think it is important that the article should detail the fact that at least in some prescribing jurisdictions there are practices in place that limit the potential for depressive/adverse/addictive behaviours upon initiation or cessation of treatment, appropriately.

It also informs potential users that it may not be feasible to use the compound as-and-when, and that the fluctuation of the dose has effects which can be harmful. Though I am not on a crusade this is one reason why recreational use poses more significant hazards – tolerance and depression are more likely due to “spiked” levels of medication.

Apologies for lack of documentary sources at this moment – I am not on my usual computer. I am not a pharmacist, but a reasonably well read chemist, so apologies if I have made errors in the use of pharmacology terms.

I have also edited the Equasym dosage to show 20 mg tablets, at least available in the UK: http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=7288

Removed problem quote (unreferenced) from controversy section

I cut out a line of the controversy bit. It was an unreferenced quote supposedly from an NIH article, and I had originally decided to leave a "needs a reference" tag, but then went ahead and checked the document1998 NIH Consensus statement on ADHD in question, finding that the line in the wiki was not in fact a direct quote but a misleading paraphrase of one cherry-picked ½ sentence and another fact without any context.

The actual article noted that there was no perfect test for ADHD and no absolute evidence of brain problems (the word “malfunction” appears only in a true or false quiz at the end of the document”, not as it was quoted in the wiki). The article also noted, however, that Schitzophrenia and other mental illnesses were similarly lacking perfect tests or absolute proof of actual brain problems, but this made them no less real or relevent conditions. The most recent release by the same institution, with more recent research, actually says “Most substantiated causes appear to fall in the realm of neurobiology and genetics” (8 years more recent).

All in all, it seemed to me the line in question was sloppy, outdated, poorly documented and I suspect written with an ideological bent and a desire to mislead.

Oh, and as a disclaimer I’m an adult with ADHD who does not currently choose to take medication for my condition, but have in the past. I'm neither a shill for drug companies nor rabidly anti-meds or anti-psychiatry.

Wilsonstark 16:04, 14 August 2007 (UTC)

I also fixed the "risk of death" section. Whether intentionally or not, the author again cherry-picked words from the referenced government article and left out a key qualifier. This medication will not cause otherwise-healthy children to fall over dead, and the issue in the actual article referenced is strictly for those children with significant cardiovascular defects. The only real concern health-wise is that some children might have undiagnosed defects of this type. I therefore felt the information was important enough to keep in the article, so parents are aware that a check of the child's cardio system would be wise before starting medication (not all family doctors would automatically do this) but it needed to be re-written so as not to give the erroneous impression that Ritalin will cause heart problems, or lead to a fatal cardiac arrest.

Wilsonstark 16:42, 14 August 2007 (UTC)

[Agreed on the first point - the document even has this nice line just before the part you quote: "There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods." Given common rebutals of the condition, due to varying levels of prevalence/diagnosis in different societal settings, this might be nice to put in the Article too. Nothing against your second point but I haven't checked any docs to quote so I'm going to remain officially neutral (and anecdotally agree; and I'm in the same situation as you, but currently taking MPH.)]

References

1. [3] might help to get rid of need reference for over 75 are boys.
2. [4] for the trachecardia
3. [5] for Arterial hypertension
4. [6] for the D/L-amphetamine discussion
5. [[7]] blured vision
6. [8] abdominal pain
7. [9] muscle twitches
8. [10] dizziness
9. [11] euphoria

additional Abuse and toxicity of methylphenidate. Therapeutics and toxicology Current Opinion in Pediatrics. 14(2):219-223, April 2002 -Stone 09:34, 17 August 2007 (UTC)

Wilsonstark 18:41, 20 August 2007 (UTC)

help please

I put in the reference for "This is not a documented side effect in medical literature" in the side effects section, but the link doesn't show right. Also, references after that seem hideosly bjorked and I'm afraid I don't know how to hunt things down well enough to see who broke them (for the record, wasn't me)

Wilsonstark 18:41, 20 August 2007 (UTC)

WP:CITET should help you here --lucid 18:43, 20 August 2007 (UTC)

Lucid, do you mind fixing the overall reference list? It appears it was your edit that messed up the references (looking through the history).

Wilsonstark 18:48, 20 August 2007 (UTC)

"not used in medical literature"

Please find a reference that says that. As it is, it's merely a listing of side effects, it does not say that the subject has not been discussed professionally --lucid 19:09, 20 August 2007 (UTC)

It is very hard to prove a negative. I frankly agree with the earlier editor who removed that "zombie" bit entirely. At best, it should probably be placed in the "controversy" section, as it is hardly medical information and the 'references' are anecdotal. That being said, I've put enough work into this one today I think. I'm not really sure why there's a side effects section when there's a side bar for side effects, but who knows.

Wilsonstark 19:33, 20 August 2007 (UTC)

Given it's such a well spread and well known negative, it should be easy to prove it. Putting it in controversy would be wrong, as it is blatantly something that is unintentionally caused by the drug, not a controversy over it's use or such. --lucid 19:37, 20 August 2007 (UTC)

I think you miss my point, I should have been clearer. The negative that is hard to prove is "not used in the medical literature". Regardless, I've just dumped what I wrote and fixed the sentence I objected to so that it makes the point the original author intended (I think) without being so sloppy and controversial in choice of words. I hope that is acceptable (see below)

Wilsonstark 19:59, 20 August 2007 (UTC)

A reasonable compromise?

I think i've fixed that side effects bit about zombies to look better, used the quotes accurately and thus I've removed my quibble about the 'zombie' bit. You will note that I have not attempted to eliminate the claim, which I admit is certainly out there, but I've helped to define the terms and used two of the supplied references to do it.

I quite intentionally removed the link to http://www.drday.com/attentiondeficit.htm If you would go check that site out, you will note that it is a part of a promotional web page, and adds nothing either to the claim re. being a zombie (other than referencing that others have used it) and certainly doesn't have anything to add. In my opinion it's inclusion adds nothing and violates the standards [12] for self-published content.

Wilsonstark 19:56, 20 August 2007 (UTC)

1- However 'out there' you think the claim is, it is very, very common, again as a quick google search will show. 2-I won't edit war with you, since there are more than enough RS out there, but you should read WP:RS before you remove things like that again. Just because a website sells things doesn't mean it isn't reliable. -lucid 20:05, 20 August 2007 (UTC)

1. I agree, it common,although of the many people I have known whose kids have been on Ritalin, very few complained of this, and of the few that did 2 of 3 were on inappropriate doses (one much too high, the other well below recommended doseage).

2. I have read WP:RS carefully. Thank you for pointing it out earlier. "Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications. However, caution should be exercised when using such sources: if the information in question is really worth reporting, someone else is likely to have done so."

Dr. Day is hardly an established expert in this field. Honestly, did you read that page?

Look at the bottom under "Prevention and Treatment:

"13. Trust in God and teach your child to trust in God. Study the Bible and pray with your child every day. Read Bible stories to your child. Children (and adults) become like those they admire. If they learn about Jesus, they will admire Him and want to be like Him. This has the most calming influence of all. For more information on the harmful effects to the brain and nervous system from the problems of modern life, watch my video "Turn on the Light."

So in the last bit she implies that Jesus will cure your ADHD (I'm a Christian, but that's not a really scientific point) and then that "Turn on the Light" is a hyperlink to http://www.drday.com/light.htm which DOES, in fact, sell you that video for $19.95 USD. The video promises to explain "Why drugs never cure depression or anxiety". Seriously, this Dr. Day is a crackpot at worst, and a cynical opportunist at best.

Honestly, that reference had no merrit, and removing it was the correct thing to do. Wilsonstark 20:15, 20 August 2007 (UTC)

cancer risk

I looked into that article on cancer risk, and TBH it was pretty dodgy (sample size too small, etc), but in my never-ending search to be fair, I left it pretty much alone and checked for related research. I found that there was rather a ton of scientific comment on the 2005, most of it quite critical of methods, lack of information, etc. But I did find this nice, professionally written, peer-reviewed AND public domain article that sought to take the 2005 findings and do the ultimate scientific job of replicating his results. That study just didn't find the same results at all, despite using a good methodology, etc. Regardless, though, the genie is out of the bottle and some people have heard of the supposed cancer risk, so it seemed to me wise to leave the reference to the 2005 article and just add in the published refutation.

From what I read of the 2007 article, there is no evidence that Ritalin causes cancer. On the other hand, they can't actually prove that it doesn't (not can we prove Fritos don't cause cancer) so I guess everyone is back to square one. Anyway, it is that 2007 article that I included with my edit, as an additional paragraph after the discussion of the 2005 article.

I swear there is more work on the controversial sides of this article than on the factual side.

Wilsonstark 20:54, 30 August 2007 (UTC)

Focalin?

What is the differance betwean Focalin and Focalin XR? My son age 9 has been on both, reacts well to focalin but not the XR. I'm trying to undersand why.The doctor says they are the same thing. (74.170.235.57 21:26, 14 September 2007 (UTC))

Consult a different doctor. We can't give medical advice Nil Einne 07:46, 27 September 2007 (UTC)

Help With History Ritalin

I and trying to remember an article which stated Ritalin was a drug designed for the VA for WWII veterans in VA hospitals. From what I recall it was to improve mood and increase energy.

Anyone remember anything about this??

Dennis —Preceding unsigned comment added by 70.104.173.185 (talk) 03:08, 16 September 2007 (UTC)

The theraputic effects of the drug were accidentally discovered in 1937. It was first used in 60's and was approved for ADHD by the FDA in 1975. See Wikipedia-adhd-history. I don't remember reading anything about ww2 veterans but it may be true.--scuro 12:50, 16 September 2007 (UTC)

Cite 17

Citation 17 fails to come up with anything (I'm on Firefox if it matters), could it be fixed? --66.67.187.203 01:00, 24 September 2007 (UTC)

Do we drink Ritalin?

Please visit this website for more information. Never Trusted 03:39, 27 September 2007 (UTC)

effects of it on people who dont have ADHD

what happens when people who dont have ADHD take the drug for short and extended periods of time. —Preceding unsigned comment added by 86.161.33.131 (talk) 16:49, 27 September 2007 (UTC)

Well, it's a stimulant that enhances focus, so I'd assume that they'd get improved focus and be hype for a good deal of the day, and would probably also get the side-effects --66.67.187.203 00:05, 28 September 2007 (UTC)

this is true from my own experiences i have found that the first time it its taken it does what you would expect. increases focus and reduces feelings of hunger and drowsiness, but its long term abuse is not known to me and id like to know if there are any studies on the long term use of ritalin in patients that dont exibit the symptoms of add at all. —Preceding unsigned comment added by 144.82.218.235 (talk) 04:12, 16 January 2008 (UTC)

No Ritalin is a neurostimulant, meaning that it would just make you very quiet if you didn't have ADHD. And you would get teh side effects. Medic9999 (talk) 13:17, 16 April 2008 (UTC)

ryetalin from star trek??

I think that's VERY obscure. It's many times more possible that the name comes from ritalinic acid! (Or is this comment just an in-joke?) user:guruclef —Preceding unsigned comment added by 200.7.17.84 (talk) 02:00, 28 September 2007 (UTC)

Effects controversy

Made some more changes to better reflect the somewhat fringe nature of the comparison between cocaine, illegal ampehetamines (speed, crystal meth) and ritalin. In fact there is quite a bit of research that contests these sorts of theories, and the quoted study is not available to read full-text. I also noted the researchers in question seem to be using mice for test subjects, and I am not clear on how mouse trials could indicate causes of schitzophrenia (which can't actually be diagnosed in rodents and I doubt is even possible in the rat brain). The addiction research for Ritalin is pretty clear. It is NOT habit forming when taken as prescribed, although it can be abused by the stupid/demented who will crush it and snort it or inject it.

On the other hand, it is research and all, so I felt deleting it would be inappropriate given the collaborative nature of wikipedia, etc. I noted from reading the original post and the posting history of the individual a pretty strong anti-medication/anti-psychatiry bias. I myself am not pro or anti medication, and I'm interested in the views of other neutral parties as well. —Preceding unsigned comment added by Wilsonstark (talk • contribs) 17:07, 15 October 2007 (UTC)

ADHD, not ADD

The first line of the wiki article says that Methylphenidate is used as treatment for ADD... there is no such disorder. According to DSM-IV, there is only ADHD (of varying types). —Preceding unsigned comment added by 70.62.102.158 (talk) 02:23, 16 October 2007 (UTC)

It's a tad complicated. Basically the issue is that many folks, including doctors and workers in the field, still prefer the "ADD" label simply because the 'H' in ADHD is a bit of a red herring, hyperactivity being less common and a lot of cases being "without hyperactivity". That being said, quite correct about the definition in the DSM. On the other hand, I believe Europe uses a completely different standard, and I think they still call it ADD (although admittedly I'm talking out of my, um, ear.

Wilsonstark 13:21, 16 October 2007 (UTC)

i dont know about the rest of europe but in England we call it both add and adhd depending on wether hyperactivity is indeed present. however when pushed most people refer to it as adhd —Preceding unsigned comment added by 144.82.218.235 (talk) 04:19, 16 January 2008 (UTC)

Safety on the developing brain?

The second paragraph under 'Known or suspected risks to health' starts like this, "A 2006 review assessing the safety of methylphenidate on the developing brain found that in animals with psychomotor impairments, structural and functional parameters of the dopamine system were improved with treatment."

This paragraph shows a possible benefit of the drug, therefor shouldn't it be under the main part of effects? I'm not a Wiki-Pro, so I'll let somebody else make the decision, I just thought I'd put it out there. —Preceding unsigned comment added by 130.17.62.245 (talk) 20:55, 18 October 2007 (UTC)

Where is research from Joseph Biedermann?!

If you are going to talk about the psychopharmacology of methylphenidate to treat ADHD, it will not be taken seriously in academia without a citation from J. Biedermann! He is the foremost psychiatrist on biological interventions for ADHD. —Preceding unsigned comment added by 71.138.139.146 (talk) 05:55, 27 October 2007 (UTC) thats an opinion isnt it? im sure there are other psychiatrists that are just as 'good' however it does seem a shame to leave out such a seemingly important figure. some one with better knowlege should place a citation if it seems to be relivent.

Article needs restructuring and additional sections

http://en.wikipedia.org/wiki/WP:MEDMOS#Drugs --scuro (talk) 13:00, 20 November 2007 (UTC)